Recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection

Abstract

During treatment of acute type A aortic dissection there is potential for both pre- and intra-operative malperfusion. There are a number of monitoring strategies that may allow for earlier detection of potentially catastrophic malperfusion (particularly cerebral malperfusion) phenomena available for the anaesthetist and surgeon. This review article sets out to discuss the benefits of the current standard monitoring techniques available as well as desirable/experimental techniques which may serve as adjuncts in the monitoring of these complex patients.

Figure 1

Subtypes and complications of aortic dissection, (a) type A and (b) type B aortic dissections. Type A encompasses Debakey I (ascending aorta only and therefore less potential for malperfusion phenomena) and II and type B Debakey III classifications. Reproduced with permission from Golledge and Eagle [4].

Figure 2

Malperfusion phenomena associated with acute type A dissection, (a) malperfusion is secondary to true lumen compression by the false lumen and (b) occlusion of the branch vessel by extension of the false lumen. Reproduced with permission from Reece et al. [5].

Figure 3

Kaplan Meier survival curves of actuarial survival of patients with cerebral malperfusion syndrome undergoing acute type A aortic dissection repair. Reproduced with permission from Geirsson et al. [36].